Note: This thread is related to #Coronavirus #COVID19

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Colleen Farrell, MD+ Your Authors @colleenmfarrell Internal medicine resident in New York City. Soon-to-be pulmonary and critical care fellow. Writer. Creator of @MedHumChat. Views mine. May. 09, 2020 2 min read + Your Authors

Wow. This is a powerful story on epidemiologist @DrEricDing raising alarm re covid and getting serious blowback.

He admits he didn’t get *everything* right. But neither did the many doctors who insisted “It’s just the flu!” (which we now know is totally wrong) 1/

Reminds me of @DrMattMcCarthy saying on March 2nd “expect widespread disruptions in daily life.” People (doctors) accused him of spreading panic and using scare tactics. 2/

This @NewYorker article taught me a lot about persuasion and risk in epidemiology. Read it.

“Being approximately right most of the time is better than being precisely right occasionally.” Interesting, thought provoking. 3/

 https://www.newyorker.com/magazine/2020/05/04/seattles-leaders-let-scientists-take-the-lead-new-yorks-did-not 

One of the deep ironies of the this entire discussion is many doctors' fears about causing panic.

So much of my medical training and practice has been focused on addressing small risks of very bad outcomes. 4/

In primary care clinic, I try to persuade people to drink 4 liters of laxatives, have diarrhea until their stool is clear, and let someone put a camera up their behind, all to look for a possible cancer that may or may not be there. I do this because it saves lives! 5/

I convince people to take a pill everyday for years to lower cholesterol to prevent a heart attack or stroke that may not have ever happened in the first place. But based on population level data, this saves lives and I do it. 6/

I tell my patients that uncontrolled diabetes can lead to blindness, dialysis, amputations, erectile dysfunction in an effort to help them understand why cutting back on carbs and getting more exercise is important. 7/

What I am saying is, in normal medicine, we tell relatively healthy people all the time that they have a risk of colon cancer, heart attack, diabetes and its complications. I strive to do this in a way that isn't fear-mongering. But my patients have a right to this information 8/

And sometimes we issue warnings before we know for sure what the patient might have. If you have night sweats and a bloody cough, you have to go in an isolation room until we rule out tuberculosis. Until we make sure that chest pain isn't a heart attack, don't get on a plane. 9/

Anyway, given that that is my baseline experience in clinical medicine, I find it interesting that when experts in infectious diseases, epidemiology, and public health raised alarm about covid, they were accused of scare tactics and causing panic, often by other doctors. 10/

I am not sure what to make of that. Everything looks different in the rear-view mirror. I'm genuinely curious what others think about how we manage risk and fear in medicine, at the individual patient and population level. I am still learning, and want to do my best. 11/11


You can follow @colleenmfarrell.



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